The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy
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ORIGINAL PAPER
The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy Seyfettin Erdem . Mine Karahan . Sedat Ava . Zafer Pekkolay . Atilim Armagan Demirtas . Ugur Keklikci
Received: 19 May 2020 / Accepted: 25 June 2020 Ó Springer Nature B.V. 2020
Abstract Purpose This study aimed to compare static and dynamic pupil responses of diabetic patients with and without nonproliferative diabetic retinopathy (DR) and normal healthy individuals under different lighting conditions via quantitative automated pupillometry. Methods Forty patients with DM with nonproliferative DR (group 1), 40 patients with DM without DR (group 2), and 40 healthy controls (group 3) underwent a complete ophthalmologic examination. Static pupillometry [scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD] and dynamic pupillometry (resting PD, contraction amplitude, latency, duration, velocity of contraction, dilatation latency, and duration and velocity at rest) were measured via automatic quantitative pupillometry. Results Analysis of variance revealed that scotopic PD [F(2, 117) = 6.42; p = 0.02], mesopic PD [F(2,
S. Erdem (&) M. Karahan S. Ava U. Keklikci Department Ophthalmology, Dicle University Medical Faculty, 21280 Diyarbakır, Turkey e-mail: [email protected] Z. Pekkolay Department of Internal Medicine, Dicle University Medical Faculty, 21280 Diyarbakır, Turkey A. A. Demirtas Department Ophthalmology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
117) = 3.20; p = 0.04], and low photopic PD [F(2, 117) = 4.86; p = 0.009] were significantly different among the groups. Scotopic PD and low photopic PD were significantly lower in group 1 than in group 2 (p = 0.03 and p = 0.03, respectively). Meanwhile, the resting diameter, velocity of pupil contraction, and velocity of pupil dilatation were found to be significantly lower (p = 0.02, p = 0.01, and p = 0.008, respectively), and the duration of pupil contraction was significantly higher in group 1 than in group 3 (p = 0.03). Conclusion Both DM patients with and without nonproliferative DR exhibited pupillary involvement. Automated pupillometry may be an easily applicable, noninvasive screening option for reducing mortality and morbidity rates associated with diabetic autonomic neuropathy. Keywords Pupillometry Diabetic retinopathy Diabetic autonomic neuropathy
Introduction Diabetic retinopathy (DR), which affects more than 90 million people worldwide, remains the leading cause of vision loss in adults [1]. Early diagnosis and treatment of DR, which occurs as a complication of diabetes mellitus (DM), is crucial for the prevention of blindness [2, 3].
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Int Ophthalmol
Diabetic autonomic neuropathy (DAN), a subclinical and early outcome of DM, is a common diabetes complication that affects the cardiovascular, gastrointestinal, genitourinary, and ocular systems and causes significant morbidity and mortality [4–6]. As such, it is important
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